A new study in the Journal of Women's Health reported that hormone replacement therapy may not have the horrible effects we think:
Some researchers are testing a new theory, that hormone therapy is beneficial for the heart when it is initiated early, during a narrow "window of opportunity" around the time of menopause and before women develop an excessive buildup of atherosclerotic plaque.
A chief criticism of the hormone study, part of the national Women's Health Initiative, was that it included women much older than the average hormone user, who typically initiates therapy around the time of menopause. The average age of the participants in the study was 64. The average age of menopause is 51.4, and some studies suggest that women who initiate hormone therapy later may miss the chance to benefit from the treatment.
This month, a paper in The Journal of Women's Health added credence to that idea. It reported that women who started therapy soon after menopause reduced the risk of coronary heart disease 30 percent, but that the benefit appeared to diminish the longer women waited to initiate treatment.
I understand the criticism that the women in the study were older on average and that could have affected the results. But there's two different things happening here. One is that menopause is uncomfortable and frustrating. The other is that medicine looks at menopause as a disease to "fix".
Now that women are living longer there's good reason to try and relieve discomfort associated with menopause. But we should be wary of the pharmaceutical industry's push for HRT. They have a lot riding on widespread hormone use -- for years it was touted as a product that makes you "look younger".
Talk about this "window of opportunity" is unsettling too, mostly because it's almost impossible to find out when that is. For some women it might be 48, others 52. And if you miss the window, you're taking a substantial risk.
Hormones are still on the market, and you can believe doctors who say things like this are prescribing it for people who aren't suffering from severe menopause symptoms:
"Personally, in my heart of hearts, I think there is a benefit," said Dr. Mary Jane Minkin, a clinical professor of obstetrics and gynecology at Yale. "However," Dr. Minkin said, "I'm politically incorrect if I say that." ... "Three years ago, the message was, 'You're going to die if you don't stop taking this,' " said Dr. Minkin, who takes estrogen and is a paid speaker for drug companies that make the estrogen products she prescribes.
Sorry doctor, but "heart of hearts" isn't a good enough reason to prescribe a product that has been proven to increase the risk of heart disease, breast cancer, and stroke. The fact that she's a paid speaker for drug companies isn't easing my mind either.
For some people, the risks associated with hormones are a reasonable trade-off. But when doctors are whispering in patient's ears "don't worry, hormones are perfectly safe", that trade-off isn't made clear.
Also the data in that study comes from the Nurses Health Study, so it doesn't address a lot of the confounding that made earlier studies of HRT so positive while the randomized trial was negative.
Posted by: Martin | February 01, 2006 at 05:05 PM